Tua’s Toughest Decision: Football Fame vs. Lifelong Brain Health

After Miami Dolphins quarterback Tua Tagovailoa received a third NFL career concussion diagnosis during a game against the Buffalo Bills, doctors warned that Tagovailoa should retire. He received all three concussions within the last 24 months, which has not only raised concerns about Tagovailoa’s health, but also surrounding safety and concussion protocol in the NFL. Although hard hits and injuries are the nature of football, the NFL needs to reevaluate whether there are opportunities to increase safety for players while keeping the game’s roots, and whether those changes are worth implementing.

This year, after running head-on into Buffalo Bills safety Damar Hamlin, Tagovailoa suffered a Grade Two concussion on a scale from one to four. After impact, he lay on the ground in a fencing position involuntarily, with one arm bent toward the body and the other stretched out, which typically signifies a more serious concussion. For Tagovailoa, this followed a Grade One concussion in September 2022, and a Grade Three concussion in December 2022. Multiple concussions like this increase the chances of long-term health issues including chronic traumatic encephalopathy (CTE).  

CTE is a severe brain condition common in high-contact sports athletes, especially NFL players. “The condition slowly damages parts of the brain and may cause trouble with memory, other thinking skills, behavior, personality, speech, or balance,” said Dr. Bennet Omalu, the first to discover and publish findings on CTE in American football players and one of the leading advocates for Tagovailoa’s retirement. "If I were his brother, his father, his uncle, cousin, nephew, if I were a member of his family, I would beg him to retire."  In fact, researchers at the Boston University CTE Center studied the brains of 376 deceased former NFL players and diagnosed 345 of them with CTE, 91.7% of those studied. The risk is high.

However, despite doctor's warnings and clear evidence of the repercussions of repeated head injuries, Tagovailoa, at least for now, has decided not to retire. Notably, if Tagovailoa is medically cleared to return but opts to retire, he forgoes the remaining $124 million on his NFL contract, barring a settlement. And, if medically forced into retirement, he has the right to collect the $124 million. For now, Tagovailoa has been placed on injured reserve and has entered the NFL’s concussion protocol, which requires players diagnosed with a concussion to follow a five-step return to participation process. However, Tagovailoa must consider whether his love for the game and his hefty $124 million contract are worth the potential long-term consequences, and if he is willing to potentially sacrifice the rest of his life for either.

 Personally, this choice hits close to home. My dad’s uncle, Dave Herman, was a starting offensive guard for the New York Jets from 1965-73 and was on the field when they won Super Bowl III. He was also one of the first football players diagnosed with CTE while alive, which is unique considering most former players with CTE are typically diagnosed after death through brain tissue analysis. When Herman was playing, not only was the safety equipment subpar, but he was also taught that “you block with your head.” Later in his life, after experiencing common symptoms of CTE, such as memory loss, he was taken to Mount Sinai. There, doctors debated whether he had Alzheimer's or CTE. A scan determined that Herman’s brain had a lot of abnormal protein, which is the hallmark sign of CTE. After this diagnosis, Herman reflected, “If I knew back then what the implications were, I’m not sure I would have played 10 years, or if I would have played at all."

In an attempt to reduce player injuries, the NFL has implemented mandatory use of Guardian Caps for linemen and running backs in preseason practices, position-specific helmets, stricter penalties for repeat helmet-to-helmet contact, and changing kickoff rules to move the fair-catch line. However, none of these changes have significantly impacted lowering concussion rates. NFL’s executive VP overseeing player health and safety Jeff Miller says the solution is “to try to find a way to keep the foot in the game, make that play exciting and yet make it less risky than the previous version of it.” 

Tagovailoa’s concussion and the reaction from doctors and the public serve as a dark window into a future where the NFL doesn’t take greater responsibility for reducing player injuries. As the season continues and injuries rack up, discussions around safety will only increase. We can only hope that innovative protocols to prevent injuries, concussions, and, most importantly, CTE, will be designed and implemented in future seasons and adopted for other high-contact sports.